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Medigap vs. Medicare Advantage

Do you have Medicare and are you looking to fill the gaps on coverage and/or get assistance with Medicare costs? You can choose to enroll in a Medicare Supplement Policy (Medigap) in addition to Original Medicare or to enroll in a Medicare Advantage Plan.  Let’s see if we can simplify this - here’s a look at the differences between these options.

Medicare Advantage

A Medicare Advantage plan is entirely separate from Medicare.  The plans wrap everything all in one policy: It includes all of the benefits of Original Medicare, has a cap on out-of-pocket costs (the current out of pocket maximum for 2019 is $6,700), and some may even offer extra benefits for things like routine vision, dental, and hearing care. You agree to use the plan’s network of providers except in emergencies. You’ll pay copays for your health care treatment as you go along as most policies have a low to no monthly premium. Most also include Part D coverage for prescription drugs.

Medicare Supplement Plans = Medigap

A Medigap plan will pick up the tab for all or part of your deductibles and coinsurance under Original Medicare (the level of coverage you get depends on the Medigap plan you choose). Medicare Supplements pay as secondary insurance – they pay after Medicare first pays its portion of the bill.  You still have Original Medicare, and Medicare sends the balance of your bills to your Medicare Supplement company. You can see any provider that participates in Medicare, regardless of which supplement company you choose. You have access to all the Medicare providers nationwide – no referrals necessary.  And depending on what plan you enroll, you may have minimal out of pocket costs, including copays at the doctor’s office.

Medigap plans do not cover prescription drugs, therefore, you must purchase a stand-alone, Part D plan for your prescription coverage.  

Prescription Drug Plans – Part D

Medicare prescription drug coverage is an optional benefit offered to everyone who has Medicare. Medicare Part D is a federal program administered through private insurance companies.  If you decide not to get Medicare drug coverage when you're first eligible, you'll likely pay a late enrollment penalty if you join later, unless you have other creditable prescription drug coverage.  In most states, you can find plans starting around $15 a month.

There are 2 ways to get prescription drug coverage.  One, through a stand-alone Medicare Prescription Drug Plan (Part D, sometimes called PDPs) or through your Medicare Advantage Plan. 

When can I make changes?

With a Medicare Supplement Plan, you can make changes and apply at any time of year – but in most states, you will have to pass medical underwriting to do so.

The Annual Election Period (AEP) in the fall, October 15th through December 7th is for Part D drug plan changes and Medicare Advantage plan changes only. You could leave a Medicare Advantage plan during this time and apply for a Medicare supplement instead. But in most cases, the insurance company will perform medical underwriting to see if you qualify. It is not guaranteed that you will be approved for the supplement coverage.

Need help sorting through all of your Medicare options.  Let us help figure out if a Medigap plan or Advantage plan is better for you.  We will assist every step of the way and provide support at no additional cost. Speak with a licensed agent today 1-866-MEDIGAP(633-4427).